Medical Matters: Fabric of general practice disintegrating thanks to HSE policies

GPs all over Ireland have become whistleblowers. They are attending rallies and going to the public and the politicians to tell them that the fabric of general practice in Ireland is disintegrating.

General practitioners are generally an unshockable lot. They never know what will come in the door next, and if you have been in the business for some years, as I have, you get the feeling that you have heard it all.

We have certainly heard enough from the HSE and the Government. The cut to the health service in general is 18 per cent; general practice has been cut by 38 per cent.

Just a few years ago a GMS contract to look after an average number of patients ensured a good living. There was a rule of thumb applied when you would consider looking at a vacant post. You would spend a third on business costs, a third on tax and have a third for yourself. If the business got too big, you had to employ more staff to cope and expand the premises so the costs went up .With a cut in income of 38 per cent you can see where that leaves you.

It is not all about money. GPs are worried for their patients, their families, their communities and their futures. Rural areas and areas of deprivation are especially in danger.

When I began my career in general practice, a GMS list was the ultimate aim. Today I know of vacant GP jobs that have been repeatedly turned down, and mature GPs with families are closing up and leaving the country. Far more GP trainees than ever before now see no future in Ireland.

However, Irish doctors are in demand and well thought of abroad even as they are discarded and undermined at home. They are being actively head hunted for work in Canada, Australia, Qatar and several other countries.

Ran smoothly
I remember with fondness the North Western Health Board, which did all that it could to make sure our practices ran smoothly. Like Mordor, the great impenetrable HSE stretches out to obfuscate, intimidate and satisfy its own agendas.

There seems to be no philosophy of investing, improving and building on success.

The network of GPs which is democratic, fair and efficient is the only part of the health service that works. It should be improved by working with the people who have built it into the success it is, instead of smashing it up and reinventing it to a bureaucrat’s dream of what the world should be like.

The HSE way of going about things seems to be that you destroy before you build. They ran down rural hospitals before putting any resources into bigger ones. Now they seem to want to destroy general practice before any new model comes in.

Maybe they want huge corporate primary care centres run by multinational companies. Maybe they want us practicing out of a rented room above a newsagent. Who knows?

I have not met many GPs who are opposed to Universal Health Insurance. Like much else that has happened before, they are prepared to look at the proposals, absorb them and get on with it if it makes sense. But if this Universal Health Insurance is to work, it needs to be properly resourced.

The under-six contract has an air of the “hit me now with the child in my arms” school of politics. The babies who the politicians kiss on the stump are going to get free treatment and a lot else besides. The older person who is actually sick loses their medical card. It is taking the idea of giving a job to a busy person to the borders of lunacy.

So as GPs wonder how they will replace broken equipment, as they lay off their staff and stare in dismay at their tax bill, they are confronted with this proposal.

The absolutely unfair thing about it is that doctors cannot negotiate with the HSE. Apparently a European Directive about the Competition Authority will not allow the medical unions to negotiate. The same European Directive does not stop the medical unions in the UK or Belgium from negotiating.

The GP service is like a great dam, dealing with 90 per cent of the health requirements of the country. This dam is cracking and springing leaks. The hospital service is already in crisis. People will suffer, and people will die.

Pat Harrold is a GP in Co Tipperary .